Search PubMed⌕ Search

Biomedical subjects

F V Coakley

Publications and source records attributed to F V Coakley.

At least 37 records · Page 2Linked to original sources
PubMed1999

Complex posttransplantation abnormalities of renal allografts: evaluation with MR imaging.

PURPOSE: To assess the efficacy of magnetic resonance (MR) imaging in the evaluation of complex abnormalities of renal allografts. MATERIALS AND METHODS: Clinical and radiologic findings were retrospectively reviewed in 24 patients who underwent MR imaging of a renal allograft because ultrasonographic (US) findings were inconclusive or discordant with clinical findings. The final diagnoses were established with histopathologic analysis (n = 16) or clinical and imaging follow-up (n = 8). RESULTS: MR imaging diagnoses were correct in 16 patients (67%), whereas US diagnoses were correct in six patients (25%) (P < .05). Five cases of allograft involvement by posttransplantation lymphoproliferative disorder (PTLD) were found at histopathologic analysis; at MR imaging, PTLD appeared as hypointense masses on T1-and T2-weighted images with minimal enhancement. In four of the five cases of PTLD, the masses occurred at the renal hilum and encased hilar vessels. Normal morphology was correctly diagnosed with MR imaging in five patients in whom a mass was suspected at US. CONCLUSION: MR imaging results are often diagnostic in cases of complex abnormalities of renal allografts. Renal allograft involvement by PTLD appears to have a relatively characteristic MR imaging appearance. Normal MR imaging findings in cases of suspected masses at US may obviate biopsy.

Female↗
PubMed1999

Complex fetal disorders: effect of MR imaging on management--preliminary clinical experience.

PURPOSE: To determine the effect of magnetic resonance (MR) imaging findings on management of complex fetal disorders. MATERIALS AND METHODS: MR imaging of the fetus was performed in 25 consecutive pregnant patients referred because of possible complex fetal disorders suspected on the basis of ultrasonographic (US) findings. Spoiled gradient-echo and single-shot rapid acquisition with relaxation enhancement MR imaging were performed in multiple planes anatomic to the fetus during maternal breath holding. RESULTS: In the fetuses in 24 of 25 women, MR studies were technically satisfactory. MR imaging directly influenced fetal care in four (17%) of 24 cases by demonstrating congenital high airway obstruction syndrome, congenital hemochromatosis, unilateral cerebellar deficiency in association with congenital diaphragmatic hernia, and severe facial disfigurement due to a giant anterior neck mass. In eight (33%) cases, MR imaging provided supplementary findings, but did not affect fetal care. In 12 (50%) cases, MR imaging results confirmed US findings. CONCLUSION: In cases of complex fetal disorders, MR imaging results can be used to supplement or confirm US findings and may directly affect management.

Abnormalities, Multiple↗
PubMed1999

Diffuse retroperitoneal amyloidosis due to renal cell carcinoma.

The case of a 61-year-old man with haematuria, in whom CT demonstrated a solid renal mass and extensive retroperitoneal infiltration, is presented. This combination of CT findings resulted in significant diagnostic uncertainty. Pathological analysis demonstrated renal cell carcinoma, with secondary amyloidosis in the retroperitoneum. Amyloidosis secondary to renal cell carcinoma has not been previously described as a cause of retroperitoneal infiltration.

Amyloidosis↗
PubMed1998

Effect of breathing on the detection of in vivo simulated pulmonary nodules by spiral CT.

OBJECTIVE: To determine the effect of breathing on the detection of small dense pulmonary nodules of threshold conspicuity by spiral computed tomography (SCT). MATERIALS AND METHODS: Forty pulmonary nodules of high density were created by endobronchial deployment of 2 and 4mm diameter beads in the peripheral airways of five anaesthetized dogs. SCT was performed during induced breath-hold and quiet breathing, using 5 mm collimation, pitch 2 and reconstruction of contiguous 5 mm slices. Scans were reviewed by six radiologists. Detection rates were measured as the number of nodules seen by at least one reader. The data was modelled using ordinal logistic regression for repeated measures, and the Wald Chi-square statistic used to test if there was a breath-hold vs. breathing effect on reader confidence level. RESULTS: There was no difference in detection rates for breath-hold vs. breathing SCT (28 vs. 25, respectively; P=0.48). This was also true when only the 2 mm nodules (n=24) were considered (12 vs. 11, respectively; P=0.77). Reader confidence level was significantly higher for breath-hold vs. breathing SCT (Wald Chi-square statistic with 6 degrees of freedom=19.0; P=0.0041). CONCLUSION: SCT can be performed during quiet breathing without a significant reduction the overall detection rate for small dense pulmonary nodules, though reader diagnostic confidence level is reduced.

Animals↗
PubMed1998

Inconclusive clinical and ultrasound evaluation of the scrotum: impact of magnetic resonance imaging on patient management and cost.

OBJECTIVES: To determine the diagnostic utility and net cost of magnetic resonance imaging (MRI) in the management of clinically and sonographically inconclusive scrotal lesions. METHODS: A multicenter retrospective review identified 34 patients diagnosed with scrotal MRI following inconclusive clinical and ultrasound (US) evaluation. Final diagnoses were based on surgery (n = 18) or clinical and US follow-up (n = 16). Final diagnoses of 29 testicular lesions were as follows: orchitis (n = 11), infarct (n = 6), neoplasm (n = 6), rupture (n = 3), torsion (n = 2), and radiation fibrosis (n = 1). Final diagnoses of five extratesticular lesions were as follows: epididymitis (n = 2), epididymal abscess (n = 2), and neoplasm (n = 1). Management plans prior to and following MRI findings were formulated by a general urologist and a urologic oncologist. The costs of the pre-MRI and post-MRI management plans were estimated using the Medicare reimbursement schedule. RESULTS: The leading US diagnosis was correct for 10 of 34 patients (29%) and the leading MRI diagnosis was correct for 31 of 34 patients (91%). MRI improved the management plan of the general urologist and urologic oncologist in 19 patients (56%) and 17 patients (50%), respectively. MRI worsened the management plan of both clinicians in 1 patient. Management was unchanged in all other patients. The overall net cost savings were $543 to $730 per patient for the urologic oncologist and the general urologist, respectively, and $3833 per patient originally scheduled for surgery. CONCLUSIONS: Use of MRI after inconclusive clinical and US evaluation of scrotal lesions may improve management, decrease the number of surgical procedures, and result in net cost savings.

Adolescent↗
PubMed1998

Imaging and management of atypical testicular masses.

Most testicular masses are germ cell malignancies and require radical orchiectomy. There are other causes of testicular masses, however, some of which have characteristic imaging and clinical features. A presumptive diagnosis may be possible for some of these atypical testicular masses. This may result in testis-preserving surgery or nonoperative management.

Diagnosis, Differential↗
PubMed1998

Complex postcholecystectomy biliary disorders: preliminary experience with evaluation by means of breath-hold MR cholangiography.

PURPOSE: To assess preliminary experience with breath-hold single-shot fast spin-echo magnetic resonance (MR) cholangiography in complex postcholecystectomy biliary disorders. MATERIALS AND METHODS: MR cholangiography was performed in 17 consecutive patients referred for specialist surgical evaluation of suspected complex postcholecystectomy biliary disorders. Two readers, unaware of surgical, histopathologic, or other imaging findings, independently reviewed the MR cholangiographic images to assess the presence of biliary occlusion, peribiliary lesions, nonspecific biliary dilatation (biliary dilatation without an abrupt transition in caliber and without a visible underlying cause), bile duct stones, or biliary fistulas. Final diagnoses were established with surgery (n = 9), imaging other than MR (n = 6), and histopathologic review of the initial surgical specimen (n = 2). RESULTS: Final diagnoses were biliary occlusion (n = 8), peribiliary lesions (n = 3), nonspecific biliary dilatation (n = 3), bile duct stones (n = 2), and biliary-colonic fistula (n = 1). The two readers correctly categorized these diagnoses in 15 (88%) and 13 (76%) of the 17 cases, with excellent interobserver agreement (kappa = 0.82). CONCLUSION: Single-shot fast spin-echo MR cholangiography is an accurate, noninvasive modality for the assessment of complex postcholecystectomy biliary disorders.

Adult↗
PubMed1998

Maximum intensity projection images in the detection of simulated pulmonary nodules by spiral CT.

This study was undertaken to investigate the use of maximum intensity projection (MIP) images in the detection of pulmonary nodules by spiral CT (SCT). 40 pulmonary nodules of high density were created by endobronchial deployment of 2 and 4 mm beads in the peripheral airways of five anesthetized dogs. Standard SCT was performed with 5 mm collimation, pitch 2 and reconstruction of contiguous slices. MIP images were generated from overlapped slabs of seven consecutive 3 mm slices, reconstructed at 2 mm intervals and acquired at pitch 2. Scans were reviewed by six radiologists. The data were modelled using ordinal logistic regression for repeated measures, and the Wald chi 2 statistic used to test if there was a difference in nodule detection and reader confidence level between the two techniques. MIP imaging increased the odds of nodule detection by 2.18 (p = 0.0002). Reader confidence level for nodule detection was significantly higher with MIP images (p < 0.00001). MIP images improve the detection rate for small high density pulmonary nodules and increase reader confidence level, when compared with standard SCT.

Animals↗
PubMed1998

Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.

OBJECTIVE: The purpose of this study was to investigate the use of breath-hold single-shot fast spin-echo MR cholangiopancreatography in neoplastic pancreaticobiliary duct obstruction. MATERIALS AND METHODS: Breath-hold MR cholangiopancreatography was performed for preoperative examination of 32 consecutive patients with pathologically confirmed neoplastic obstruction of the biliary tract or pancreatic duct using a single-shot fast spin-echo sequence. Two observers, unaware of clinical or pathologic findings, independently reviewed the MR cholangiopancreatograms to assess level of obstruction and site of underlying tumor. Pathologic diagnoses, based on surgical or CT-guided biopsy specimens, were pancreatic tumor (n = 12), gallbladder cancer (n = 9), intrahepatic cancer (n = 9), and ampullary cancer (n = 2). RESULTS: On the basis of conventional cholangiography, CT, and surgical findings, 20 patients had isolated bile duct obstruction, 11 patients had combined pancreatic and bile duct obstruction, and one patient had isolated pancreatic duct obstruction. Isolated bile duct obstruction was classified as lobar (n = 5), hilar (n = 12), or distal (n = 3). These levels of obstruction were correctly identified in 27 (84%) and 28 (88%) of the 32 cases by the two observers. The site of the underlying tumor was identified in 27 (84%) and 29 (91%) cases by the two observers. Good interobserver agreement was reached for both level of obstruction (kappa = .70) and identification of tumor site (kappa = .75). CONCLUSION: Breath-hold single-shot fast spin-echo MR cholangiopancreatography is accurate in identifying the level of obstruction and the site of underlying tumor in neoplastic pancreaticobiliary duct obstruction, with good interobserver agreement.

Adult↗
PubMed1997

Detection of pulmonary metastases with pathological correlation: effect of breathing on the accuracy of spiral CT.

BACKGROUND: CT of the chest for suspected pulmonary metastases in adults is generally performed using a breath-hold technique. The results may not be applicable to young children in whom breath-holding may be impossible. OBJECTIVE: Determine the effect of breathing on the accuracy of pulmonary metastasis detection by spiral CT (SCT). MATERIALS AND METHODS: Prior to euthanasia four anesthetized dogs with metastatic osteosarcoma underwent SCT with a collimation of 5 mm and a pitch of 2, during both induced breath-hold and normal quiet breathing. Images were reconstructed as contiguous 5-mm slices. Macroscopically evident metastases were noted at postmortem. Hard-copy SCT images were reviewed by ten radiologists, each of whom circled all suspected metastases. SCT images were compared with postmortem results to determine true and false positives. RESULTS: The pathologist identified 132 macroscopically evident pulmonary metastases. For metastasis detection, there was no significant difference between breath-hold SCT and breathing SCT. CONCLUSION: In our animal model, SCT can be performed during normal resting breathing without significant loss of accuracy in the detection of pulmonary metastases.

Animals↗
PubMed1996

An investigation into perihilar inflammatory change on the chest radiographs of children admitted with acute respiratory symptoms.

PURPOSE: To determine the incidence, correlation with selected parameters and interobserver variability of radiographic perihilar inflammatory change (PIC) in previously well children under 3 years of age, who were hospitalized with acute respiratory symptoms. PATIENTS AND METHODS: A total of 113 previously well children under 3 years of age who were hospitalized with acute respiratory symptoms, and whose chest radiographs (CRGs) showed no focal pulmonary abnormality, were prospectively identified. The CRGs were read blindly by two radiologists. Each scored the degree of PIC on a five point scale as absent (0), borderline/equivocal/indeterminate (1), mild but definite (2), moderate (3) and severe (4). RESULTS: PIC was read as definitely present (mean PIC score greater than or equal to 2) in 65 (58%) patients. The mean PIC score correlated with overinflation (r = 0.45, P < 0.01) and patient temperature (r = 0.22, P < 0.05). The mean PIC score was significantly higher (2.1 vs 1.5, P < 0.01) in those receiving antibiotics (n = 69). It was also significantly higher (2.4 vs 1.7, P < 0.01) in those receiving supplemental oxygen (n = 26). PIC was not associated with duration of admission, presence of wheeze (n = 79), use of nebulized bronchodilators (n = 61) or RSV positivity (n = 32). The k value for interobserver variability indicated only fair agreement (k = 0.29) between the two readers on the five point scale and moderate agreement (k = 0.41) when the data was pooled into two groups (0 and 1 vs 2, 3 and 4). CONCLUSIONS: PIC is a common radiographic finding in children under 3 years of age who are hospitalized with acute respiratory symptoms. It is positively but weakly correlated with temperature, hyperinflation, antibiotic usage and supplemental oxygen administration. It is subject to substantial interobserver variability.

Acute Disease↗
PubMed1996

Case report: bladder opacification following enteral iopamidol as a sign of occult intestinal infarction.

A case of intestinal infarction due to superior mesenteric artery embolism is described in a 30-year-old female with Crohn's disease. This was accompanied by bladder opacification following enteral iopamidol administered at endoscopic retrograde cholangiopancreatography. The likely mechanism of this finding is transmural and transperitoneal absorption of enteral contrast medium and its significance as a sign of mesenteric ischaemia is discussed.

Adult↗
PubMed1995

Childhood ossification of the anterior longitudinal ligament of the cervical spine.

Two paediatric cases of acquired ossification of the cervical anterior longitudinal ligament are described. This has not been previously reported in childhood. The first was associated with corrosive ingestion requiring oesophagectomy and colonic interposition and the second with acute lymphoblastic leukaemia initially presenting as idiopathic hypereosinophilic syndrome. Possible mechanisms are discussed.

Cervical Vertebrae↗
PubMed1995

Direct and indirect MRI findings in ganglion cysts of the common peroneal nerve.

MRI findings in three cases of ganglion cyst of the common peroneal nerve are presented. In each case the cyst was imaged as an oval structure in transverse section section adjacent to the fibular neck. The cyst extended in a tubular fashion over several slices with an inferior extension towards the superior tibiofibular joint. Signal intensity was intermediate on T1- and high on T2-weighted images. In addition, increased signal on both T1- and T2-weighted images was noted throughout the peroneal compartment and was associated with clinical and EMG evidence of denervation. This has not been previously described but may be an important indirect sign which, when seen, should prompt a careful search in the region of the fibular neck for an underlying ganglion cyst of the common peroneal nerve.

Adolescent↗
PubMed1995

The aetiology and distinguishing features of solitary spinal hot spots on planar bone scans.

PURPOSE: To determine the aetiology of solitary spinal hot spots on planar bone scans and to determine which radiographic and scintigraphic features aid in distinguishing benign from malignant lesions. MATERIALS AND METHODS: 81 bone scans showing a solitary hot spot in the spine were identified. Aetiology was determined in 73 based on imaging and clinical findings, including clinical follow-up. The location of the hot spot was classified as paravertebral (related to the lateral spinal margin), panvertebral (diffuse uptake confined within a vertebra), hemivertebral (uptake confined between the midline and lateral spinal margin) or complex (all others). RESULTS: The aetiology of the spinal hot spot was benign in 55 patients and malignant in 18. The latter all belonged to the subgroup of 42 patients with a known malignancy. Only eight of the 18 malignant cases had suggestive plain radiographic findings. There was no significant relationship between aetiology and age. The spinal level of the hot spot was cervical in three (all benign), thoracic in 16 (eight benign) and lumbar in 54 (44 benign). The hot spot was paravertebral in 21 (all benign), panvertebral in 24 (20 benign), hemivertebral in 13 (10 benign) and complex in 15 (only four benign). CONCLUSIONS: Most (75%) solitary spinal hot spots are benign, and even in patients with known malignancy just over half (57%) are benign. Malignant lesions are often (56%) radiographically occult. Thoracic or complex hot spots are more likely to be malignant while paravertebral hot spots are characteristically benign. These features may be helpful in distinguishing benign and malignant lesions in patients with a known malignancy and unremarkable radiographs. Other scintigraphic features are unhelpful in distinguishing benign from malignant lesions.

Adolescent↗